{ "_id": "5b58b5cdd7c8ac639fd9614a", "bundle_id": "5a57e977942c6d1e61d32f14", "calculate_sdes": true, "category": "Miscellaneous", "cms_id": "CMS123v7", "complexity": { "variables": [ { "name": "Patient", "complexity": 1 }, { "name": "SDE Ethnicity", "complexity": 1 }, { "name": "SDE Payer", "complexity": 1 }, { "name": "SDE Race", "complexity": 1 }, { "name": "SDE Sex", "complexity": 1 }, { "name": "Initial Population", "complexity": 3 }, { "name": "Denominator", "complexity": 1 }, { "name": "Sensory Foot Exam", "complexity": 2 }, { "name": "Visual Foot Exam", "complexity": 2 }, { "name": "Pedal Pulse Checked", "complexity": 2 }, { "name": "Numerator", "complexity": 3 }, { "name": "Bilateral Lower Extremity Amputation", "complexity": 1 }, { "name": "Left Lower Extremity Amputation", "complexity": 1 }, { "name": "Right Lower Extremity Amputation", "complexity": 1 }, { "name": "Denominator Exclusions", "complexity": 4 }, { "name": "Patient", "complexity": 1 }, { "name": "Encounter", "complexity": 1 }, { "name": "LengthInDays", "complexity": 1 }, { "name": "Inpatient Encounter", "complexity": 2 }, { "name": "ToDate", "complexity": 1 }, { "name": "CalendarAgeInDaysAt", "complexity": 1 }, { "name": "CalendarAgeInDays", "complexity": 1 }, { "name": "CalendarAgeInMonthsAt", "complexity": 1 }, { "name": "CalendarAgeInMonths", "complexity": 1 }, { "name": "CalendarAgeInYearsAt", "complexity": 1 }, { "name": "CalendarAgeInYears", "complexity": 1 }, { "name": "Hospitalization", "complexity": 0 }, { "name": "Hospitalization Locations", "complexity": 0 }, { "name": "Hospitalization Length of Stay", "complexity": 1 }, { "name": "Hospital Admission Time", "complexity": 1 }, { "name": "Hospital Discharge Time", "complexity": 1 }, { "name": "Hospital Arrival Time", "complexity": 1 }, { "name": "Hospital Departure Time", "complexity": 1 }, { "name": "Emergency Department Arrival Time", "complexity": 1 }, { "name": "First Inpatient Intensive Care Unit", "complexity": 1 }, { "name": "Patient", "complexity": 1 }, { "name": "Has Hospice", "complexity": 3 }, { "name": "Patient", "complexity": 1 }, { "name": "Qualifying Encounters", "complexity": 1 } ] }, "continuous_variable": false, "cql": [ "library DiabetesFootExam version '7.5.000'\r\n\r\nusing QDM version '5.3'\r\n\r\ninclude Adult_Outpatient_Encounters version '1.1.000' called AdultOutpatientEncounters\r\ninclude Hospice version '1.0.000' called Hospice\r\ninclude MATGlobalCommonFunctions version '2.0.000' called Global\r\n\r\ncodesystem \"SNOMEDCT:2017-09\": 'urn:oid:2.16.840.1.113883.6.96' version 'urn:hl7:version:2017-09'\r\n\r\nvalueset \"ONC Administrative Sex\": 'urn:oid:2.16.840.1.113762.1.4.1'\r\nvalueset \"Race\": 'urn:oid:2.16.840.1.114222.4.11.836'\r\nvalueset \"Ethnicity\": 'urn:oid:2.16.840.1.114222.4.11.837'\r\nvalueset \"Payer\": 'urn:oid:2.16.840.1.114222.4.11.3591'\r\nvalueset \"Bilateral amputation of leg below or above knee\": 'urn:oid:2.16.840.1.113883.3.464.1003.113.12.1056'\r\nvalueset \"Diabetes\": 'urn:oid:2.16.840.1.113883.3.464.1003.103.12.1001'\r\nvalueset \"Left\": 'urn:oid:2.16.840.1.113883.3.464.1003.122.12.1036'\r\nvalueset \"Left Unilateral Amputation Procedure Above or Below Knee\": 'urn:oid:2.16.840.1.113883.3.464.1003.113.12.1072'\r\nvalueset \"Right\": 'urn:oid:2.16.840.1.113883.3.464.1003.122.12.1035'\r\nvalueset \"Right Unilateral Amputation Procedure Above or Below Knee\": 'urn:oid:2.16.840.1.113883.3.464.1003.113.12.1073'\r\nvalueset \"Unilateral Amputation Procedure Below or Above Knee, Unspecified Laterality\": 'urn:oid:2.16.840.1.113883.3.464.1003.103.12.1022'\r\nvalueset \"Unilateral Amputation Below or Above Knee, Unspecified Laterality\": 'urn:oid:2.16.840.1.113883.3.464.1003.113.12.1059'\r\nvalueset \"Left Unilateral Amputation Above or Below Knee\": 'urn:oid:2.16.840.1.113883.3.464.1003.113.12.1058'\r\nvalueset \"Right Unilateral Amputation Above or Below Knee\": 'urn:oid:2.16.840.1.113883.3.464.1003.113.12.1057'\r\n\r\ncode \"Diabetic foot examination (regime/therapy)\": '401191002' from \"SNOMEDCT:2017-09\" display 'Diabetic foot examination (regime/therapy)'\r\ncode \"Monofilament foot sensation test (procedure)\": '134388005' from \"SNOMEDCT:2017-09\" display 'Monofilament foot sensation test (procedure)'\r\ncode \"Pedal pulse taking (procedure)\": '91161007' from \"SNOMEDCT:2017-09\" display 'Pedal pulse taking (procedure)'\r\n\r\nparameter \"Measurement Period\" Interval\r\n\r\ncontext Patient\r\n\r\ndefine \"SDE Ethnicity\":\r\n\t[\"Patient Characteristic Ethnicity\": \"Ethnicity\"]\r\n\r\ndefine \"SDE Payer\":\r\n\t[\"Patient Characteristic Payer\": \"Payer\"]\r\n\r\ndefine \"SDE Race\":\r\n\t[\"Patient Characteristic Race\": \"Race\"]\r\n\r\ndefine \"SDE Sex\":\r\n\t[\"Patient Characteristic Sex\": \"ONC Administrative Sex\"]\r\n\r\ndefine \"Denominator\":\r\n\t\"Initial Population\"\r\n\r\ndefine \"Numerator\":\r\n\texists ( \"Sensory Foot Exam\" )\r\n\t\tand exists ( \"Visual Foot Exam\" )\r\n\t\tand exists ( \"Pedal Pulse Checked\" )\r\n\r\ndefine \"Pedal Pulse Checked\":\r\n\t[\"Assessment, Performed\": \"Pedal pulse taking (procedure)\"] PedalPulseCheck\r\n\t\twhere PedalPulseCheck.result is not null\r\n\t\t\tand PedalPulseCheck.authorDatetime during \"Measurement Period\"\r\n\r\ndefine \"Visual Foot Exam\":\r\n\t[\"Assessment, Performed\": \"Diabetic foot examination (regime/therapy)\"] FootExamVisual\r\n\t\twhere FootExamVisual.result is not null\r\n\t\t\tand FootExamVisual.authorDatetime during \"Measurement Period\"\r\n\r\ndefine \"Bilateral Lower Extremity Amputation\":\r\n\t[\"Diagnosis\": \"Bilateral amputation of leg below or above knee\"] LowerBilateralAmputation\r\n\t\twhere LowerBilateralAmputation.prevalencePeriod starts on or before end of \"Measurement Period\"\r\n\r\ndefine \"Sensory Foot Exam\":\r\n\t[\"Assessment, Performed\": \"Monofilament foot sensation test (procedure)\"] MonofilamentTest\r\n\t\twhere MonofilamentTest.result is not null\r\n\t\t\tand MonofilamentTest.authorDatetime during \"Measurement Period\"\r\n\r\ndefine \"Denominator Exclusions\":\r\n\tHospice.\"Has Hospice\"\r\n\t\tor exists ( \"Bilateral Lower Extremity Amputation\" )\r\n\t\tor ( exists ( \"Left Lower Extremity Amputation\" )\r\n\t\t\t\tand exists ( \"Right Lower Extremity Amputation\" )\r\n\t\t)\r\n\r\ndefine \"Initial Population\":\r\n\texists ( [\"Patient Characteristic Birthdate\"] Birthdate\r\n\t\t\twhere Global.\"CalendarAgeInYearsAt\"(Birthdate.birthDatetime, start of \"Measurement Period\")in Interval[18, 75 )\r\n\t)\r\n\t\tand exists ( AdultOutpatientEncounters.\"Qualifying Encounters\" )\r\n\t\tand exists ( [\"Diagnosis\": \"Diabetes\"] Diabetes\r\n\t\t\t\twhere Diabetes.prevalencePeriod overlaps \"Measurement Period\"\r\n\t\t)\r\n\r\ndefine \"Left Lower Extremity Amputation\":\r\n\t( ( ( [\"Diagnosis\": \"Unilateral Amputation Below or Above Knee, Unspecified Laterality\"]\r\n\t\t\tunion [\"Procedure, Performed\": \"Unilateral Amputation Procedure Below or Above Knee, Unspecified Laterality\"] ) UnilateralAmputation\r\n\t\t\twhere UnilateralAmputation.anatomicalLocationSite in \"Left\"\r\n\t)\r\n\t\tunion ( [\"Diagnosis\": \"Left Unilateral Amputation Above or Below Knee\"]\r\n\t\t\t\tunion [\"Procedure, Performed\": \"Left Unilateral Amputation Procedure Above or Below Knee\"]\r\n\t\t) ) LeftLowerAmputation\r\n\t\twhere Coalesce(LeftLowerAmputation.prevalencePeriod, LeftLowerAmputation.relevantPeriod)starts on or before end of \"Measurement Period\"\r\n\r\ndefine \"Right Lower Extremity Amputation\":\r\n\t( ( ( [\"Diagnosis\": \"Unilateral Amputation Below or Above Knee, Unspecified Laterality\"]\r\n\t\t\tunion [\"Procedure, Performed\": \"Unilateral Amputation Procedure Below or Above Knee, Unspecified Laterality\"] ) UnilateralAmputation\r\n\t\t\twhere UnilateralAmputation.anatomicalLocationSite in \"Right\"\r\n\t)\r\n\t\tunion ( [\"Diagnosis\": \"Right Unilateral Amputation Above or Below Knee\"]\r\n\t\t\t\tunion [\"Procedure, Performed\": \"Right Unilateral Amputation Procedure Above or Below Knee\"]\r\n\t\t) ) RightLowerAmputation\r\n\t\twhere Coalesce(RightLowerAmputation.prevalencePeriod, RightLowerAmputation.relevantPeriod)starts on or before end of \"Measurement Period\"\r\n", "library MATGlobalCommonFunctions version '2.0.000'\r\n\r\nusing QDM version '5.3'\r\n\r\ncodesystem \"LOINC:2.46\": 'urn:oid:2.16.840.1.113883.6.1' version 'urn:hl7:version:2.46'\r\ncodesystem \"SNOMEDCT:2016-03\": 'urn:oid:2.16.840.1.113883.6.96' version 'urn:hl7:version:2016-03'\r\n\r\nvalueset \"Emergency Department Visit\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.292'\r\nvalueset \"Encounter Inpatient\": 'urn:oid:2.16.840.1.113883.3.666.5.307'\r\nvalueset \"Intensive Care Unit\": 'urn:oid:2.16.840.1.113762.1.4.1110.23'\r\n\r\ncode \"Birthdate\": '21112-8' from \"LOINC:2.46\" display 'Birth date'\r\ncode \"Dead\": '419099009' from \"SNOMEDCT:2016-03\" display 'Dead'\r\n\r\nparameter \"Measurement Period\" Interval\r\n\r\ncontext Patient\r\n\r\ndefine \"Encounter\":\r\n\t[\"Encounter, Performed\": \"Emergency Department Visit\"]\r\n\r\ndefine \"Inpatient Encounter\":\r\n\t[\"Encounter, Performed\": \"Encounter Inpatient\"] EncounterInpatient\r\n\t\twhere \"LengthInDays\"(EncounterInpatient.relevantPeriod)<= 120\r\n\t\t\tand EncounterInpatient.relevantPeriod ends during \"Measurement Period\"\n\n/*ToDate takes a given DateTime value and returns a DateTime with the time components \"zeroed\", and the timezone of the input value, for example, given the DateTime @2012-01-01T06:30:00.0Z, this function will return @2012-01-01T00:00:00.0Z.*/\r\n\r\ndefine function \"ToDate\"(Value DateTime):\r\n\tDateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezone from Value)\n\n/*CalendarAgeInDaysAt calculates the calendar age (meaning the age without considering time components) in days.*/\r\n\r\ndefine function \"CalendarAgeInDaysAt\"(BirthDateTime DateTime, AsOf DateTime):\r\n\tdays between ToDate(BirthDateTime)and ToDate(AsOf)\n\n/*CalendarAgeInDays calculates the calendar age (meaning the age without considering time components) in days as of today*/\r\n\r\ndefine function \"CalendarAgeInDays\"(BirthDateTime DateTime):\r\n\tCalendarAgeInDaysAt(BirthDateTime, Today())\n\n/*CalendarAgeInMonthsAt calculates the calendar age (meaning the age without considering time components) in months.*/\r\n\r\ndefine function \"CalendarAgeInMonthsAt\"(BirthDateTime DateTime, AsOf DateTime):\r\n\tmonths between ToDate(BirthDateTime)and ToDate(AsOf)\n\n/*CalendarAgeInMonths calculates the calendar age (meaning the age without considering time components) in months as of today.*/\r\n\r\ndefine function \"CalendarAgeInMonths\"(BirthDateTime DateTime):\r\n\tCalendarAgeInMonthsAt(BirthDateTime, Today())\n\n/*CalendarAgeInYearsAt calculates the calendar age (meaning the age without considering time components) in years.*/\r\n\r\ndefine function \"CalendarAgeInYearsAt\"(BirthDateTime DateTime, AsOf DateTime):\r\n\tyears between ToDate(BirthDateTime)and ToDate(AsOf)\n\n/*CalendarAgeInYears calculates the calendar age (meaning the age without considering time components) in years as of today.*/\r\n\r\ndefine function \"CalendarAgeInYears\"(BirthDateTime DateTime):\r\n\tCalendarAgeInYearsAt(BirthDateTime, Today())\n\n/*Hospitalization returns the total interval for admission to discharge for the given encounter, or for the admission of any immediately prior emergency department visit to the discharge of the given encounter.*/\r\n\r\ndefine function \"Hospitalization\"(Encounter \"Encounter, Performed\"):\r\n\t( singleton from ( [\"Encounter, Performed\": \"Emergency Department Visit\"] EDVisit\r\n\t\t\twhere EDVisit.relevantPeriod ends 1 hour or less on or before start of Encounter.relevantPeriod\r\n\t) ) X\r\n\t\treturn if X is null then Encounter.relevantPeriod else Interval[start of X.relevantPeriod, end of Encounter.relevantPeriod]\n\n/*calculates the difference in calendar days between the start and end of the given interval.*/\r\n\r\ndefine function \"LengthInDays\"(Value Interval):\r\n\tdifference in days between start of Value and end of Value\n\n/* returns list of all locations within an encounter, including locations for immediately prior ED visit. If data contains many encounters within 1 hour before the start of encounter error will occur indicating the hospitalization cannot be determined*/\r\n\r\ndefine function \"Hospitalization Locations\"(Encounter \"Encounter, Performed\"):\r\n\t( singleton from ( [\"Encounter, Performed\": \"Emergency Department Visit\"] EDVisit\r\n\t\t\twhere EDVisit.relevantPeriod ends 1 hour or less on or before start of Encounter.relevantPeriod\r\n\t) ) EDEncounter\r\n\t\treturn if EDEncounter is null then Encounter.facilityLocations else flatten { EDEncounter.facilityLocations, Encounter.facilityLocations }\n\n/*Returns the length of stay in days (i.e. the number of days between admission and discharge) for the given encounter, or from the admission of any immediately prior emergency department visit to the discharge of the encounter*/\r\n\r\ndefine function \"Hospitalization Length of Stay\"(Encounter \"Encounter, Performed\"):\r\n\tLengthInDays(\"Hospitalization\"(Encounter))\n\n/*Returns admission time for an encounter or for immediately prior emergency department visit. If the data contain many encounters within 1 hour before the start of the encounter an error indicating hospitalization cannot be determined\n*/\r\n\r\ndefine function \"Hospital Admission Time\"(Encounter \"Encounter, Performed\"):\r\n\tstart of \"Hospitalization\"(Encounter)\n\n/*Hospital Discharge Time returns the discharge time for an encounter*/\r\n\r\ndefine function \"Hospital Discharge Time\"(Encounter \"Encounter, Performed\"):\r\n\tend of Encounter.relevantPeriod\n\n/*Returns earliest arrival time for an encounter including any prior ED visit. If the data contain multiple encounters within 1 hour before the start of the encounter, an error will occur indicating it cannot be unambiguously determined\n*/\r\n\r\ndefine function \"Hospital Arrival Time\"(Encounter \"Encounter, Performed\"):\r\n\tstart of First((\"Hospitalization Locations\"(Encounter))HospitalLocation\r\n\t\t\tsort by start of locationPeriod\r\n\t).locationPeriod\n\n/*Returns the latest departure time for encounter including any prior ED visit. If the data contain multiple encounters within 1 hour before the start of the encounter, an error will occur indicating it cannot be unambiguously determined*/\r\n\r\ndefine function \"Hospital Departure Time\"(Encounter \"Encounter, Performed\"):\r\n\tend of Last((\"Hospitalization Locations\"(Encounter))HospitalLocation\r\n\t\t\tsort by start of locationPeriod\r\n\t).locationPeriod\n\n/*Returns the arrival time in the ED for the encounter. If the data contain multiple encounters within 1 hour before the start of the encounter or multiple ED locations an error will occur indicating it cannot be determined\n*/\r\n\r\ndefine function \"Emergency Department Arrival Time\"(Encounter \"Encounter, Performed\"):\r\n\tstart of ( singleton from ( ( \"Hospitalization Locations\"(Encounter)) HospitalLocation\r\n\t\t\t\twhere HospitalLocation.code in \"Emergency Department Visit\"\r\n\t\t)\r\n\t).locationPeriod\n\n/*First Inpatient Intensive Care Unit returns the first intensive care unit for\nthe given encounter, without considering any immediately prior emergency\ndepartment visit.*/\r\n\r\ndefine function \"First Inpatient Intensive Care Unit\"(Encounter \"Encounter, Performed\"):\r\n\tFirst((Encounter.facilityLocations)HospitalLocation\r\n\t\t\twhere HospitalLocation.code in \"Intensive Care Unit\"\r\n\t\t\t\tand HospitalLocation.locationPeriod during Encounter.relevantPeriod\r\n\t\t\tsort by start of locationPeriod\r\n\t)\r\n", "library Hospice version '1.0.000'\r\n\r\nusing QDM version '5.3'\r\n\r\ncodesystem \"LOINC:2.46\": 'urn:oid:2.16.840.1.113883.6.1' version 'urn:hl7:version:2.46'\r\ncodesystem \"SNOMEDCT:2016-03\": 'urn:oid:2.16.840.1.113883.6.96' version 'urn:hl7:version:2016-03'\r\ncodesystem \"SNOMEDCT:2017-03\": 'urn:oid:2.16.840.1.113883.6.96' version 'urn:hl7:version:2017-03'\r\ncodesystem \"SNOMEDCT:2017-09\": 'urn:oid:2.16.840.1.113883.6.96' version 'urn:hl7:version:2017-09'\r\n\r\nvalueset \"Encounter Inpatient\": 'urn:oid:2.16.840.1.113883.3.666.5.307'\r\nvalueset \"Hospice care ambulatory\": 'urn:oid:2.16.840.1.113762.1.4.1108.15'\r\n\r\ncode \"Birthdate\": '21112-8' from \"LOINC:2.46\" display 'Birth date'\r\ncode \"Dead\": '419099009' from \"SNOMEDCT:2016-03\" display 'Dead'\r\ncode \"Discharge to healthcare facility for hospice care (procedure)\": '428371000124100' from \"SNOMEDCT:2017-09\" display 'Discharge to healthcare facility for hospice care (procedure)'\r\ncode \"Discharge to home for hospice care (procedure)\": '428361000124107' from \"SNOMEDCT:2017-09\" display 'Discharge to home for hospice care (procedure)'\r\n\r\nparameter \"Measurement Period\" Interval\r\n\r\ncontext Patient\r\n\r\ndefine \"Has Hospice\":\r\n\texists ( [\"Encounter, Performed\": \"Encounter Inpatient\"] DischargeHospice\r\n\t\t\twhere ( DischargeHospice.dischargeDisposition as Code ~ \"Discharge to home for hospice care (procedure)\"\r\n\t\t\t\t\tor DischargeHospice.dischargeDisposition as Code ~ \"Discharge to healthcare facility for hospice care (procedure)\"\r\n\t\t\t)\r\n\t\t\t\tand DischargeHospice.relevantPeriod ends during \"Measurement Period\"\r\n\t)\r\n\t\tor exists ( [\"Intervention, Order\": \"Hospice care ambulatory\"] HospiceOrder\r\n\t\t\t\twhere HospiceOrder.authorDatetime during \"Measurement Period\"\r\n\t\t)\r\n\t\tor exists ( [\"Intervention, Performed\": \"Hospice care ambulatory\"] HospicePerformed\r\n\t\t\t\twhere HospicePerformed.relevantPeriod overlaps \"Measurement Period\"\r\n\t\t)\r\n", "library Adult_Outpatient_Encounters version '1.1.000'\r\n\r\nusing QDM version '5.3'\r\n\r\ncodesystem \"LOINC:2.46\": 'urn:oid:2.16.840.1.113883.6.1' version 'urn:hl7:version:2.46'\r\ncodesystem \"SNOMEDCT:2016-03\": 'urn:oid:2.16.840.1.113883.6.96' version 'urn:hl7:version:2016-03'\r\n\r\nvalueset \"Office Visit\": 'urn:oid:2.16.840.1.113883.3.464.1003.101.12.1001'\r\nvalueset \"Annual Wellness Visit\": 'urn:oid:2.16.840.1.113883.3.526.3.1240'\r\nvalueset \"Preventive Care Services - Established Office Visit, 18 and Up\": 'urn:oid:2.16.840.1.113883.3.464.1003.101.12.1025'\r\nvalueset \"Preventive Care Services-Initial Office Visit, 18 and Up\": 'urn:oid:2.16.840.1.113883.3.464.1003.101.12.1023'\r\nvalueset \"Home Healthcare Services\": 'urn:oid:2.16.840.1.113883.3.464.1003.101.12.1016'\r\n\r\ncode \"Birthdate\": '21112-8' from \"LOINC:2.46\" display 'Birth date'\r\ncode \"Dead\": '419099009' from \"SNOMEDCT:2016-03\" display 'Dead'\r\n\r\nparameter \"Measurement Period\" Interval\r\n\r\ncontext Patient\r\n\r\ndefine \"Qualifying Encounters\":\r\n\t( [\"Encounter, Performed\": \"Office Visit\"]\r\n\t\tunion [\"Encounter, Performed\": \"Annual Wellness Visit\"]\r\n\t\tunion [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\r\n\t\tunion [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\r\n\t\tunion [\"Encounter, Performed\": \"Home Healthcare Services\"] ) ValidEncounter\r\n\t\twhere ValidEncounter.relevantPeriod during \"Measurement Period\"\r\n" ], "cql_statement_dependencies": { "DiabetesFootExam": { "Patient": [ ], "SDE Ethnicity": [ ], "SDE Payer": [ ], "SDE Race": [ ], "SDE Sex": [ ], "Initial Population": [ { "library_name": "MATGlobalCommonFunctions", "statement_name": "CalendarAgeInYearsAt" }, { "library_name": "Adult_Outpatient_Encounters", "statement_name": "Qualifying Encounters" } ], "Denominator": [ { "library_name": "DiabetesFootExam", "statement_name": "Initial Population" } ], "Sensory Foot Exam": [ ], "Visual Foot Exam": [ ], "Pedal Pulse Checked": [ ], "Numerator": [ { "library_name": "DiabetesFootExam", "statement_name": "Sensory Foot Exam" }, { "library_name": "DiabetesFootExam", "statement_name": "Visual Foot Exam" }, { "library_name": "DiabetesFootExam", "statement_name": "Pedal Pulse Checked" } ], "Bilateral Lower Extremity Amputation": [ ], "Left Lower Extremity Amputation": [ ], "Right Lower Extremity Amputation": [ ], "Denominator Exclusions": [ { "library_name": "Hospice", "statement_name": "Has Hospice" }, { "library_name": "DiabetesFootExam", "statement_name": "Bilateral Lower Extremity Amputation" }, { "library_name": "DiabetesFootExam", "statement_name": "Left Lower Extremity Amputation" }, { "library_name": "DiabetesFootExam", "statement_name": "Right Lower Extremity Amputation" } ] }, "MATGlobalCommonFunctions": { "CalendarAgeInYearsAt": [ { "library_name": "MATGlobalCommonFunctions", "statement_name": "ToDate" } ], "ToDate": [ ] }, "Adult_Outpatient_Encounters": { "Qualifying Encounters": [ ] }, "Hospice": { "Has Hospice": [ ] } }, "created_at": "2018-07-25T17:39:25.818Z", "data_criteria": { "Payer_PatientCharacteristicPayer_028e6363_f1a0_4340_ade5_e8b4d2a93072": { "title": "Payer", "description": "Patient Characteristic Payer: Payer", "code_list_id": "2.16.840.1.114222.4.11.3591", "property": "payer", "type": "characteristic", "definition": "patient_characteristic_payer", "hard_status": false, "negation": false, "source_data_criteria": "Payer_PatientCharacteristicPayer_028e6363_f1a0_4340_ade5_e8b4d2a93072_source", "variable": false, "inline_code_list": { "Source of Payment Typology": [ "1", "11", "111", "112", "113", "119", "12", "121", "122", "123", "129", "13", "14", "19", "191", "2", "21", "211", "212", "213", "219", "22", "23", "25", "26", "29", "291", "299", "3", "31", "311", "3111", "3112", "3113", "3114", "3115", "3116", "3119", 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"value": "0056", "name": "NQF Number", "code_obj": { "type": "CD", "null_flavor": "OTH", "original_text": "NQF Number" }, "value_obj": { "type": "ED", "value": "0056", "media_type": "text/plain" } }, { "code": "COPY", "value": "This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved. \n\nLimited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications.\n\nCPT(R) contained in the Measure specifications is copyright 2004-2017 American Medical Association. LOINC(R) copyright 2004-2017 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R] ) copyright 2004-2017 International Health Terminology Standards Development Organisation. ICD-10 copyright 2017 World Health Organization. All Rights Reserved.", "name": "Copyright", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "COPY", "title": "Copyright" }, "value_obj": { "type": "ED", "value": "This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved. \n\nLimited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications.\n\nCPT(R) contained in the Measure specifications is copyright 2004-2017 American Medical Association. LOINC(R) copyright 2004-2017 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R] ) copyright 2004-2017 International Health Terminology Standards Development Organisation. ICD-10 copyright 2017 World Health Organization. All Rights Reserved.", "media_type": "text/plain" } }, { "code": "DISC", "value": "The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.\n \nDue to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].", "name": "Disclaimer", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "DISC", "title": "Disclaimer" }, "value_obj": { "type": "ED", "value": "The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.\n \nDue to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].", "media_type": "text/plain" } }, { "code": "MSRSCORE", "name": "Measure Scoring", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "MSRSCORE", "title": "Measure Scoring" }, "value_obj": { "type": "CD", "system": "2.16.840.1.113883.1.11.20367", "code": "PROPOR", "title": "Proportion" } }, { "code": "MSRTYPE", "name": "Measure Type", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "MSRTYPE", "title": "Measure Type" }, "value_obj": { "type": "CD", "system": "2.16.840.1.113883.1.11.20368", "code": "PROCESS", "title": "PROCESS" } }, { "code": "STRAT", "value": "None", "name": "Stratification", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "STRAT", "title": "Stratification" }, "value_obj": { "type": "ED", "value": "None", "media_type": "text/plain" } }, { "code": "MSRADJ", "value": "None", "name": "Risk Adjustment", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "MSRADJ", "title": "Risk Adjustment" }, "value_obj": { "type": "ED", "value": "None", "media_type": "text/plain" } }, { "code": "MSRAGG", "value": "None", "name": "Rate Aggregation", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "MSRAGG", "title": "Rate Aggregation" }, "value_obj": { "type": "ED", "value": "None", "media_type": "text/plain" } }, { "code": "RAT", "value": "As the seventh leading cause of death in the U.S., diabetes kills approximately 79,500 people a year (CDC Health 2017). Diabetes is a long lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (CDC About Diabetes 2017). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney failure, amputation of toes, feet or legs, and premature death. (CDC At a Glance 2016). \n\nIn 2012, diabetes cost the U.S. an estimated $245 billion: $176 billion in direct medical costs and $69 billion in reduced productivity. This is a 41 percent increase from the estimated $174 billion spent on diabetes in 2007 (ADA Economic 2013). \n\nDiabetes reduces the blood flow to the extremities of the body such as the legs and feet, which make it harder for the body to heal from injuries to those parts of the body. Patients with diabetes are at higher risks of developing serious problems with their feet, toes, and legs which can lead to difficulty walking or even amputation (CDC Living with Diabetes, 2015). \n\nAccording to research from the Centers for Disease Control and Prevention (CDC), in 2010 approximately 73,000 adults with diabetes had a leg or foot amputated. Furthermore, amputations in adults with diabetes accounts for 60 percent of amputation of legs and feet, not related to an injury (CDC Living with Diabetes, 2015). Adults 45 years and older with diabetes are 10 times more likely to have an amputation of their leg or foot compared to adults without diabetes (CDC Living with Diabetes, 2015).", "name": "Rationale", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "RAT", "title": "Rationale" }, "value_obj": { "type": "ED", "value": "As the seventh leading cause of death in the U.S., diabetes kills approximately 79,500 people a year (CDC Health 2017). Diabetes is a long lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (CDC About Diabetes 2017). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney failure, amputation of toes, feet or legs, and premature death. (CDC At a Glance 2016). \n\nIn 2012, diabetes cost the U.S. an estimated $245 billion: $176 billion in direct medical costs and $69 billion in reduced productivity. This is a 41 percent increase from the estimated $174 billion spent on diabetes in 2007 (ADA Economic 2013). \n\nDiabetes reduces the blood flow to the extremities of the body such as the legs and feet, which make it harder for the body to heal from injuries to those parts of the body. Patients with diabetes are at higher risks of developing serious problems with their feet, toes, and legs which can lead to difficulty walking or even amputation (CDC Living with Diabetes, 2015). \n\nAccording to research from the Centers for Disease Control and Prevention (CDC), in 2010 approximately 73,000 adults with diabetes had a leg or foot amputated. Furthermore, amputations in adults with diabetes accounts for 60 percent of amputation of legs and feet, not related to an injury (CDC Living with Diabetes, 2015). Adults 45 years and older with diabetes are 10 times more likely to have an amputation of their leg or foot compared to adults without diabetes (CDC Living with Diabetes, 2015).", "media_type": "text/plain" } }, { "code": "CRS", "value": "American Diabetes Association (2017) Guidelines/ Recommendations: Perform annual comprehensive foot examination to identify risk factors predictive of ulcers and amputations. The foot examination should include inspection, assessment of foot/leg pulses, and testing for loss of protective sensation (10-g monofilament plus testing any one of: vibration using 128-Hz tuning fork, pinprick sensation, temperature, ankle reflexes, or vibration perception threshold). (Level of evidence: B)", "name": "Clinical Recommendation Statement", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "CRS", "title": "Clinical Recommendation Statement" }, "value_obj": { "type": "ED", "value": "American Diabetes Association (2017) Guidelines/ Recommendations: Perform annual comprehensive foot examination to identify risk factors predictive of ulcers and amputations. The foot examination should include inspection, assessment of foot/leg pulses, and testing for loss of protective sensation (10-g monofilament plus testing any one of: vibration using 128-Hz tuning fork, pinprick sensation, temperature, ankle reflexes, or vibration perception threshold). (Level of evidence: B)", "media_type": "text/plain" } }, { "code": "IDUR", "value": "Higher score indicates better quality", "name": "Improvement Notation", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "IDUR", "title": "Improvement Notation" }, "value_obj": { "type": "ED", "value": "Higher score indicates better quality", "media_type": "text/plain" } }, { "code": "REF", "value": "American Diabetes Association (ADA). April 2013. Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care. Vol. 36 no. 4\n1033-46. http://care.diabetesjournals.org/content/36/4/1033.full", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "American Diabetes Association (ADA). April 2013. Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care. Vol. 36 no. 4\n1033-46. http://care.diabetesjournals.org/content/36/4/1033.full", "media_type": "text/plain" } }, { "code": "REF", "value": "Centers for Disease Control and Prevention (CDC). 2017. About Diabetes. https://www.cdc.gov/diabetes/basics/diabetes.html.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Centers for Disease Control and Prevention (CDC). 2017. About Diabetes. https://www.cdc.gov/diabetes/basics/diabetes.html.", "media_type": "text/plain" } }, { "code": "REF", "value": "Centers for Disease Control and Prevention (CDC). 2016. At a Glance 2016, Diabetes Working to Reverse the US Epidemic. https://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2016/diabetes-aag.pdf.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Centers for Disease Control and Prevention (CDC). 2016. At a Glance 2016, Diabetes Working to Reverse the US Epidemic. https://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2016/diabetes-aag.pdf.", "media_type": "text/plain" } }, { "code": "REF", "value": "Centers for Disease Control and Prevention (CDC). 2017. Health, United States, 2016: With Chartbook on Long-term Trends in Health. https://www.cdc.gov/nchs/data/hus/hus16.pdf#019.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Centers for Disease Control and Prevention (CDC). 2017. Health, United States, 2016: With Chartbook on Long-term Trends in Health. https://www.cdc.gov/nchs/data/hus/hus16.pdf#019.", "media_type": "text/plain" } }, { "code": "REF", "value": "Centers for Disease Control and Prevention (CDC). 2015. Living with Diabetes: Keep Your Feet Healthy. https://www.cdc.gov/features/diabetesfoothealth/index.html", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Centers for Disease Control and Prevention (CDC). 2015. Living with Diabetes: Keep Your Feet Healthy. https://www.cdc.gov/features/diabetesfoothealth/index.html", "media_type": "text/plain" } }, { "code": "REF", "value": "American Diabetes Association. Microvascular complications and foot care. Sec. 10. In Standards of Medical Care in Diabetes-2017. Diabetes Care 2017;40(Suppl. 1):S88-S98", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "American Diabetes Association. Microvascular complications and foot care. Sec. 10. In Standards of Medical Care in Diabetes-2017. Diabetes Care 2017;40(Suppl. 1):S88-S98", "media_type": "text/plain" } }, { "code": "DEF", "value": "Foot exam: visual inspection with a sensory exam and a pulse exam.", "name": "Definition", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "DEF", "title": "Definition" }, "value_obj": { "type": "ED", "value": "Foot exam: visual inspection with a sensory exam and a pulse exam.", "media_type": "text/plain" } }, { "code": "GUIDE", "value": "Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.", "name": "Guidance", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "GUIDE", "title": "Guidance" }, "value_obj": { "type": "ED", "value": "Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.", "media_type": "text/plain" } }, { "code": "TRANF", "value": "TBD", "name": "Transmission Format", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "TRANF", "title": "Transmission Format" }, "value_obj": { "type": "ED", "value": "TBD", "media_type": "text/plain" } }, { "code": "IPOP", "value": "Patients 18-75 years of age with diabetes with a visit during the measurement period", "name": "Initial Population", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "IPOP", "title": "Initial Population" }, "value_obj": { "type": "ED", "value": "Patients 18-75 years of age with diabetes with a visit during the measurement period", "media_type": "text/plain" } }, { "code": "DENOM", "value": "Equals Initial Population", "name": "Denominator", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "DENOM", "title": "Denominator" }, "value_obj": { "type": "ED", "value": "Equals 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"2.16.840.1.113883.5.4", "code": "NUMER", "title": "Numerator" }, "value_obj": { "type": "ED", "value": "Patients who received visual, pulse and sensory foot examinations during the measurement period", "media_type": "text/plain" } }, { "code": "NUMEX", "value": "Not Applicable", "name": "Numerator Exclusions", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "NUMEX", "title": "Numerator Exclusions" }, "value_obj": { "type": "ED", "value": "Not Applicable", "media_type": "text/plain" } }, { "code": "DENEXCEP", "value": "None", "name": "Denominator Exceptions", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "DENEXCEP", "title": "Denominator Exceptions" }, "value_obj": { "type": "ED", "value": "None", "media_type": "text/plain" } }, { "code": "SDE", "value": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex", "name": "Supplemental Data Elements", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "SDE", "title": "Supplemental Data Elements" }, "value_obj": { "type": "ED", "value": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex", "media_type": "text/plain" } } ], "measure_id": "40280382-62C4-DE26-0162-FE2505800CC9", "measure_period": { "type": "IVL_TS", "low": { "type": "TS", "value": "201201010000", "inclusive?": true, "derived?": false }, "high": { "type": "TS", "value": "201212312359", "inclusive?": true, "derived?": false }, "width": { "type": "PQ", "unit": "a", "value": "1", "inclusive?": true, "derived?": false } }, "needs_finalize": false, "observations": [ ], "population_criteria": { "IPP": { "conjunction?": true, "type": "IPP", "hqmf_id": "7567276B-C419-4192-9302-B74184432984", "preconditions": [ { "id": 2, "preconditions": [ { "id": 1, "reference": "DiabetesFootExam__Initial_Population__C779F645_0AAB_466D_9156_9A0902679F53" } ], "conjunction_code": "allTrue" } ] }, "DENOM": { "conjunction?": 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